Your Questions
Your Questions
Q: Dr. Eppley, The shape of my skull at the back is oval. I would like to correct its shape so that it appears normal. Could you please tell me the price?
A:It is not clear to me whether you need is a skull reduction or a skull augmentation to the back of your head to have a more normal shape. I would guess based on that it is oval that it has too much projection and needs to be reduced…but I am not going to guess. I would need pictures that show your head shape concerns to provide a more informed answer.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can I continue my boxing profession with my jaw implant?
A:Lots of patients ask about doing boxing and martial arts after jaw implant surgery and my usual response is yes since it is a really a hobby and I am not concerned about the limited trauma since training is very different than competing. I don’t know how that may apply to someone who does it as a profession. I suspect the answer would be the same…but then I have never had a professional boxer have the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’d like to flatten the temporal convexity and width of the side of my head. I don’t know if Botox would be enough or if the muscle would need to be removed too?
A:It would be fair to say that muscle removal is twice as effective as Botox at reducing the muscle mass on the side of the head. The more pertinent question is whether your temporal muscle is thick enough as a thin Caucasian female that any effort at muscle reduction would make much difference.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been planning and budgeting for an aesthetic surgical procedure to address a flat spot on the occipital region (back of the head) for some time and am now ready to proceed.I am based in Canada and prefer to have the procedure here. However, I am also considering clinics in the United States if necessary.I would appreciate any information or recommendations regarding this type of surgery.
A:The definitive procedure for any type of skull augmentation is a custom implant made from the patient’s 3D CT scan. Whether anyone does this procedure in Canada I would not know.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in the cosmetic rib osteotomy procedure and comparing it to removal. I am a transgender female.
A: I have written an entire blog on the differences between these two structural waistline reduction surgeries…
https://exploreplasticsurgery.com/waistline-narrow…e-they-different/
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m wondering if you have any more before/after images of the skull reduction surgery? My head size has bothered me my whole life, and I’m very interested despite it being a huge cosmetic surgery. My main concern is where the scars usually are and how well they can be hidden afterwards
.A:The term ‘skull reduction’ is a general term which described a number of procedures. As to what you mean by that is unclear. I would need to know more specifics to provide more qualified answers to your questions.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m just wondering if u guys do revision surgery on skull reshaping?
A:The question is not whether secondary skull reshaping surgery can be done but what exactly do you need. I would need specifics as to when and what type of procedure was done as well as your current concerns with any pictuers that so illustrate.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been discussing modified aesthetic OBO and I only believe I need about 3mm of IPD increase which is well within the capabilities of your method. I had narrow eyes before skeletal expansion (MARPE) and although it did actually increase my IPD slightly, it widened my cheekbones proportionately. I think a few mm of IPD widening would not only fix my eye spacing itself, but also make my nose look more proportionate, and my face less long. Combined with some implants around the eyes to support them better, I think it would be well worth going through with the procedure, so I hope you don’t consider my eye spacing to be too borderline to be worth such a surgery. After all this I will get double jaw surgery and be done with all my surgeries.
I hope to hear back from you about what can be done about my case.
A: I would certainly agree that for 2 to 3mms of IPD increase any OBO procedure that involved a frontal craniotomy or a bicoronal incision would be a good example of a ‘solution thaf is bigger than the problem.’ Inferior subtotal orbital rim movement done through a combined lower eyelid and intraoral approaches works fine for a few mms of IPD expansion. (not as effective for IPD decrease) How that would/should work with any periorbital implants/augmentation is yet unclear. The first place to start is getting a 3D CT scan for orbital anatomy and treatment planning.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I believe I have plagiocephaly, I want to know how bad it is. All I know is I have a bulging forhead from one side. Also, my teeth are curved, chin, lips, nose etc. Also the side that they are curved to has the side of my head and ear is sticking out. I also feel like my face is bulging too from the side my forhead is bulging. Someone told me I have body dismorphia but I’m not sure. Am I exaggerating or what do you think. Also if I get braces with aligners how much better would this get?
A: How bad any aesthetic problem is depends on the patient’s interpretation of it. I think what you really mean to ask is how improvable is it by surgery. Braces is not going to change anything other than that of the teeth component of it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is the intraoral cinch suture still effective if i get it 1-2 years post op? This gave me so much clarity on the issue and I feel like I can now move on and try to get the help I need to get it fixed.
A:The intraoral cinch suture is more effective when done during the original procedure where all of the midface soft tissues have been elevated. It is more of a preventative nostril narrowing maneuver rather than as a therapeutic nostril narrowing procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Do you guys do tracheal augmentation?
A:Tracheal augmentation is done using a firm polyethylene material that has a notched V shape and is placed through a small overlying skin incision. It is placed right below the cervicomental angle over the underyling trachea. To enhance its appearance (show) submental liposuction above it is usually helpful.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have heard that this procedure rolls your shoulders forward slightly. This causes me uncertainty since i don’t want my side profile to look weird obviously but most people who seem to raise this point are people who haven’t done the surgery and most people who have done the surgery say that it is not significant. At the same time I cant seem to find very many pictures taken before and after from the side. I guess I would like to know, just how much does the shoulders slouch forward. Is there a significant risk of it being very noticeable or do most people walk away with shoulders that look narrower.
A: There is some slight anterior rotation of the shoulder but this is really only evident in the first month after the surgery where the position of the shoulders is held that way for comfort/protection. But once fully recovered there is no significant rolling in of the shoulders.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, What are your thoughts on fat grafting? Specifically in the chin area? Someone mentioned that it dissolves and others say it doesn’t. I am thinking of a chin implant but have a deep mental crease and was wondering if fat grafting would help.
A: If you are concerned about a deep labiomental in the chin, it doesn’t matter what the method of chin augmentation is (fat, implant, bony genioplasty) it is going to get deeper.
For chin augmentation fat does have a high rate of resorption and should only be considered when the amount of augmentation is needed is minor.
The real role of fat grafting in the chin is for the deeper labiomental fold when chin implant augmentation is being done to soften or mitigate the deepening effect on the depth of the fold.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I want to know if you do a procedure to reverse a buccal fat removal I want to recover the round of my face. Here I have before photos. I wanted to reduce other parts, but now I just want to recover the rounded face.
A: There are two methods of buccal lipectomy reversal….fat injections and enbloc fat graft insertion. Given the scalp of your fat loss based on your pictures the fat injection method seems best given the broad area of fat loss.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, i have a bad facial asymmetry. what do you think i should do ? what procedures. my left side is asymmetry , i recently had a rhinoplasty but it didn’t go as expected.this is how I look.
A: The two most important changes to make in your facial asymmetry is to correct the jawline and the nose (again). These two would do the most to straighten out your face.The two most important changes to make in your facial asymmetry is to correct the jawline and the nose (again). These two would do the most to straighten out your face.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have recently gotten TMJ replacement surgery, is it possible to place jaw implants at my gonial angles that would lessen the jaw angle? On my one side my ramus doesn’t drop down very far so I have a very steep jaw angle. How far can implants help with this, it would need to be significant is this possible ? If so I would like to schedule a consult in the new year
Picture attached was before surgery but the angle hasn’t changed.
A: The simple answer is that it is possible to place custom jaw angle/jawline implants with TMJ placement implants in place.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, For a while now I have been trying to remove all of my tattoos with laser and it is definitely working! The thing is, although they are black, as with every tattoo, full removal could never be guaranteed till the end.
That’s why I decided to ask an actual reconstructive surgeon to see if a THEORETICAL plan b could work. I repeat that it is THEORETICAL and I would just like to understand if the idea could be carried out on paper, even if it doesn’t translate precisely in real life, due to complications or risks.
I will slice my plan in two sections:
1)The first 3 tattoos (the gun, the letters on the hand and the numbers):
- Do you believe those tattoos could be excised or serially excised?
2)The other 3 tattoos (the one on my neck, the brain on the shoulder and the jaguar on my stomach).
- Since they are larger, could I ask if tissue expanders could THEORETICALLY be placed, so as for the surrounding skin to stretched enough for the tattoos to be excised.
I know that expanders have been used on the stomach, the shoulder area and the neck for burn reconstructions and I am also aware that they carry particular risks, especially on the extremities, such as ruptures, necrosis, infection and etc. Taking the obvious risks aside, which I have fully accepted, could this plan be done in the worst case scenario?
It probably won’t come to that at all and I will exhaust of my efforts on laser, before even considering surgery. But just knowing that such options exist, would give me so much relief and allow me to not depend only on unpredictability.
A: Your tattoos are too big for any method of serial excision. The scars they would leave by so doing would be worse than the residual tattoo pigments left by the laser treatments. You will have to stick with laser treatments and see how much they can accomplish.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I went for a consultation a few months ago to see if I would be a candidate for either jaw surgery, midface implants, or both. I had figured that I probably would benefit the most from infraorbital/submalar implants to even out the projection of my mid face, and the Surgeon checked with his partner in practice that does the jaw surgeries, who said “home run” on the idea of just doing the implants, plus a chin implant. They were very informative, and it will be quite a while before I would end up having it done, but I wanted to check with your practice since you are the most well known for the customized implants. So, my concern is basically the middle of my face. Would be grateful to hear your thoughts thank you!
A: To look at various facial reshaping changes and do imaging (which is a critical assessment…you never just eyeball potential face changes and call it a ‘homerun’) requires a consultation.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q:Dr. Eppley, I had double jaw surgery for sleep apnea recently and my cheeks are now out of harmony with the rest of my face and my jaw is fairly narrow with a fairly short ramus so it looks a bit strange and I think it would make me a very good candidate.
A: it is fairly common to see patients for custom jawline and infraorbital-malar implants after Bimax surgery, particularly for OSA. The large maxillary movement leaves the upper midface behind and the large sagittal lower jaw movement can make the lower facial third look too narrow.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am also concerned if silicone would result in aesthetic differences as they’re softer than PMMA or PEEK. Would the results not have as defined of a look around the jawline or the mandible borders?
A: There is no difference in the feel or appearance once implanted on the bone between solid silicone and PEEK. The concept of silicone being soft and not creating well defined facial shapes is false.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hello! I’m interested in shoulder reduction surgery but had a few questions. One, I’m a graphic designer. How soon after this surgery would I be about to go back to doing my work? Secondly, what are the long-term impacts on the shoulders? Should I have any concerns about that…?
A: In answer to your shoulder reduction questions:
1) Since the first 2 weeks after surgery one has to keep their elbows close to their side as a postoperative restriction (short arming it) I assume that you could not work as a graphic artist. (although maybe you could) After two weeks one can move their arms out to 45 degrees in which I assume there would be no problems working then.
2) There are no known long term issues with shoulder function. The amount of clavicle length removed (2.5cms) isn’t enough to do so.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Can you 3D print Brad Pitt’s Head shape? Is it possible to take it as an example, file the excess bones and add the missing parts to get the closest image?
A: Many patients use other people’s head and face shapes to try and emulate. Since we don’t have their 3D CT scans I have to guess what those bone shapes would be from which the 3D implants are made.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, The fundamental thing I would like to resolve is the asymmetry between the two sides of the face, in particular the eyes and the jaw. I would like to understand the causes of facial asymmetry and whether it is possible to correct it, and with what procedures (for me it is a great discomfort.
A: Like most facial asymmetries they are usually complete affecting the entire side of the face if you look close enough. The eye and jaw are usually the most apparent part of the asymmetry and both can be improved significantly. The left jaw asymmetry is treated by a custom designed implant based on the shape of the opposite right side. The left eye asymmetry is usually treated by a custom orbital floor-rim-cheek along with adjustments to the eyebrow, brow bone and eyelids.
But the first place to start in facial asymmetry is to get a 3D CT scan to assess the differences between the two facial sides as well as serves as the basis of the custom implant designs used to treat it.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering what could be done for my pointed head shape? Could the area circled in red in one of the pictures be burred down to reduce the peaked look?
A: While sagittal ridge skull reduction can be done in your case its impact on improving the peaked head shape would be very modest. The more profound change would come from parasagittal augmentation to raise up the sloped sides of the head along the sagittal ridge line. It may or may not be combined with sagittal ridge reduction based on what computer imaging shows us about its effect along with parasagittal augmentation.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am struggling with lower lip incompetence. I did bsso and a sliding genio 4 months ago. Half of my lower lip and chin are still numb. The numb side of my lip is also a bit crooked. Talking and eating is fine. I dont have much tightness except from my scar tissue inside my lower lip. But I cant seem to close my lips at rest. I just had my braces taken out. And really hoped for improvement. But it did not get better. Will this go away? Or is this my final result?
A: More healing time will answer the question of the true final outcome, like up to one year after the surgery. I would expect much of the numbness to resolve but the lower incompetence may ne another matter.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I read in your blog that you mention for someone with high gonials, using a widening jaw angle can make the face look heavier/ bulkier. How does that compare with adding vertical lengthening, as I imagine that also seemingly would add heaviness to the face?
A:That has to be determined on an individual basis by computer imaging, But as a general statement widening truly high jaw angles can make for an undesired change. Vertical elongating the high jaw angle has a lowering effect in the frontal view which may or may not be aesthetically favorable. Everyone’s facial shape is different as well as their aesthetic objectives/tolerance so it is not as simple as generalized statements.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i’ve always struggled with my appearance simply because of my high hairline and my wide forehead. kids used to call me an alien in middle / high school. i really want to get a forehead reduction along with a bilateral posterior temporal muscle reduction.
A: Forehead reduction in you poses some unique aesthetic considerations. With a high frontal hairline and a wide bony forehead and large temporal muscles you have astutely pointed out that the two are linked. You can’t change one without changing the other…meaning if you lower our hairline your forehead will look even wider due to the width of the bone and the width of the temporal muscles. Conversely if you just reduced the temporal muscles the hairline would look even higher.
As a result a frontal hairline advancement needs to be combined with a reduction in the width of the bony forehead (which can be done through the hairline incision) as well as temporal reductions done through postauricular incisions. (posterior temporal muscle removal, anterior temporal muscle transposition)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My buccal fat pads were removed when I had my LeFort surgery was done. I wanted to get your opinion as to whether it’s possible to restore them using a fat graft from some other part of my body. I don’t want to use synthetic injectables as I have a lot of concerns about them. I’d only want to do this if Dr. Eppley thinks that he can achieve a moderately satisfactory correction of the issue. I know there’s no way to actually reverse this buccal fat pad removal, but I was wondering what the state of the science and surgical practice was nowadays regarding what can be done to mitigate the loss.
.A: Buccal lipectomy reversal can be done by two methods….injection fat grafting and en bloc fat graft insertion. The fat injection method is as straightforward as it sounds and is done on the conventional injection method with the caveat that it is done from an intraoral approach given the depth of the buccal fat space. En bloc fat grafting is where a solid piece of fat is harvested, the buccal space reopened intraorally and a sold fart graft (83ccs in volume) out back directly into the buccal space. This would certainly be viewed as the anatomically accurate buccal lipectomy reversal approach.
The differences are that the fat injection method is minimally invasive and harvests the fat by liposuction but at the expense of the unpredictability of how well the fat will survive.
The en bloc or solid fat grafting method requires an intraoral open approach and harvests a fat graft by excision but with a more predictable fat graft survival.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to get large deltoid implants. I have attached some pictures of some results that would be my goal.
A:Those are subfascial deltoid implants, you just can’t see the scar by the AC joint. The key about implant thickness, besides the concept of what will fit, is that the pocket location will have a major play on the thickness/projection of the implant used. For the subfascial pocket you can get a 3cm deltoid implant while for the submuscular pocket it is 1.5cms.
The other important concept is whether one is using standard CCB implants or making them custom. Standard CCB implants have a maximum projection of 1.5cms while customs can be made to any projection.
The most relevant issue that your images show is your tolerance for the type of aesthetic shoulder change that may be acceptable. Some patients may look at that before and after and think it looks too squared out/unnatural while others may find it acceptable. I am going to assume you are the latter? That tolerance will then guide the type of implant used and pocket location for it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking to get my temporal muscles reduced. (see pictures)
A:You have distinct pattern of temporal muscle enlargement that involves both the anterior and posterior temporal zones. The relevance of that distinction is that each zone is treated differently as the thickness of the muscle and the shape of the bone underneath it are different. (see attached diagram) The posterior temporal area is treated by complete removal due to the direct access from behind the ear. This is where the muscle is the thinnest and the underlying has a convex shape. The anterior temporal area has very thick muscle and a deep bony concavity underneath it as a result. It is not possible to completely or even partially cut out the muscle in this zone nor would you want due to negative impact it would have on jaw function. The anterior muscle zone is treated with a transposition technique rather than excision which helps reduce its fullness to some degree but not as effectively as the posterior zone excision does in that area.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
